Management and outcome of pallidal deep brain stimulation in severe Huntington's disease.

Neurodegenerative movement disorders, such as Huntington's disease (HD), have become a promising field for Deep Brain Stimulation (DBS). This study aims to contribute to the establishment of a well-grounded database including both expected and unexpected effects of pallidal DBS in HD, and to discuss the ethical and legal restrictions of DBS in cognitively limited patients. Evaluation of the outcome data indicates that pallidal DBS exerted an independent effect on motor symptoms but probably also on the patient's cognitive and affective state. The cognitive decline, however, that characterizes the late stage of neurodegenerative disorders implicates ethical and legal problems given the patients' inability to give informed consent to DBS.

Classification of patients with a clinically isolated syndrome based on signs and symptoms is supported by magnetic resonance imaging results.

BACKGROUND: Recently, a clinical classification system was described to determine whether symptoms and signs of patients presenting with a first episode suggestive of multiple sclerosis (MS) indicate the presence of monofocal or multifocal disease. OBJECTIVES: To evaluate the value of this new classification system by comparing the results with those of simultaneously obtained magnetic resonance imaging (MRI) scans. METHODS: The 487 patients, randomised in the BENEFIT study, were centrally assessed using the new system and classified as monofocal or multifocal, based on clinical information by two neurologists masked for the MRI results. MRI analyses were performed by expert readers masked for the clinical classification. RESULTS: Patients classified as multifocal had more T2 hyperintense (median: 21 versus 15.5) and more T1 hypo-intense lesions (median: 2 versus 1) than those classified as monofocal. Patients classified at the local site as having evidence of a single clinical lesion, but reclassified centrally as having a clinical multifocal central nervous system presentation, had more T2 lesions than monofocal patients. In addition, patients with a multifocal presentation more often fulfilled the MRI criteria for dissemination in space, as incorporated in the International Panel (IP) diagnostic criteria for MS. CONCLUSION: These data provide justification for the recently proposed clinical classification system to be used in patients who present with a first episode suggestive of MS, in that ;multifocal', based on symptoms and signs, is associated with more lesions on MRI.

Generating autogenous cartilage on the basis of subperichondrial grafts of demineralized bone matrix with local stimulation by growth factors.

Cartilage tissue acquired de novo is a very attractive material for the surgical reconstruction of joint surfaces, trachea, and maxillofacial elements. One of the primary challenges for tissue engineering is to determine the procedures that lead to the creation of material meeting the established qualitative and quantitative criteria. The goal of this work was to determine whether and how growth factors (IGF-1 and FGF) and ethyl alcohol administered locally affect the course and final outcome of the chondrogenetic process under in vitro conditions in New Zealand rabbits. In order to generate cartilage, a collagen scaffold (demineralized ZMK bone matrix) was used, wrapped in a pedunculated flap of perichondrium (from the rabbit's ear), which, beginning on the 3rd day after the operation, was injected with growth factors every 3 days. Grafts were collected in the 3rd and 6th week after the ZMK implantation, and the silvers made from them were stained for the presence of collagen II, collagen I, and macrophages, and analyzed morphometrically. It was found that the application of growth factors only slighty, intensified the synthesis of collagen II, and had no effect on the degree of macrophage infiltration or collagen I contents, while the numerous injections exerted a negative impact on the architecture of the newly-formed tissue and contributed to an increased number of complications (hematomas, infections).

The role of trabecular demineralized bone in combination with perichondrium in the generation of cartilage grafts.

The use of a composite graft of bovine trabecular demineralized bone matrix (DBM) and perichondrium has been found a reliable method for in vivo generation of cartilage. In the present study, the mechanism whereby this commercially available matrix increases cartilage formation was investigated. First, the time course of cartilage formation in vivo, in the combined implant of perichondrium and DBM in the rabbit ear was studied, with special focus on tissue reactions to DBM. DBM was colonized by macrophages from day 3 post-operatively, reaching a maximum after 2 weeks. Only a minimal number of neutrophils was found. After 3 weeks the DBM appeared to be resorbed. In the first week the DBM was invaded with chondroblasts, and chondrogenesis occurred between the first and second week of implantation. After 3 weeks, the initially formed islets of cartilage had fused. Next, the chondrogenic capacity of DBM itself was investigated by implantation of DBM without perichondrium. This never resulted in cartilage formation. Immunohistochemistry showed only a faint staining of the DBM for growth factors. This indicates a minimal chondrogenic effect of DBM alone and the requirement of perichondrium as cell provider. In order to define the conditions which cause chondrogenesis in composites of perichondrium and DBM, a series of in vitro culture experiments was performed in which the in vivo situation was mimicked step by step. The basic condition was perichondrium cultured in medium with 10% FCS. In this condition, cartilage formation was variable. Because in the in vivo situation both DBM and macrophages can release growth factors, the effect of IGF1, TGFbeta2 or OP1 added to the culture medium was tested. Neither the incidence nor the amount of cartilage formation was stimulated by addition of growth factors. Perichondrium wrapped around DBM in vitro gave cartilage formation in the perichondrium but the incidence and amount were not significantly stimulated compared to cultures of perichondrium without DBM. However, cartilage-like cells were found in the DBM suggesting an effect of DBM on perichondrium-derived cells. Finally, macrophages and/or blood were added to the composite DBM-perichondrium to mimic the in vivo situation as close as possible. However, no effect of this treatment was found. In conclusion, this study indicates that DBM itself has few chondrogenic qualities but functions merely as a spacer for cell ingrowth. The fast resorption of DBM by macrophages in vivo seems of importance for the cartilage forming process, but in vitro the presence of macrophages (in combination with blood) could not enhance chondrogenesis.

Matching the message to the process: the relative ordering of knowledge, attitudes, and practices in behavior change research.

PIP: The authors empirically investigated the relative ordering of knowledge, attitudes, and practices in behavior change models and its relation to communicating health-related information. Considerable research has been conducted in the area of behavior change to identify and measure the presence of knowledge, attitudinal, and practice levels for many behaviors. The literature is reviewed. The authors' investigation consisted of interviewing 1680 men and women in Lima, Cusco, Huaraz, Puno, and Chimbote--5 large Peruvian cities--in 3 urban probability household surveys conducted in August 1994, January 1995, and January 1996. Six possible knowledge, attitude, and practice permutations are developed with regard to contraception in Peru. People may use contraceptive methods before they become fully knowledgeable about their chosen methods. In so doing, these users may become misinformed about contraceptive practice and become dissatisfied contraceptive users who discontinue contraceptive use. Media campaigns designed to inform the public can help produce a more satisfied and sustainable contraceptive user base. The informed choice approach can be the basis for effective communication strategies.^ieng

Mass-media-generated interpersonal communication as sources of information about family planning.

This study suggests that mass-media-generated interpersonal communication networks vary according to an individual's behavior-change stage. As people in Peru adopted modern family planning methods, they increasingly formed and perhaps relied on information from more technical interpersonal communication networks, which shifted from peers to doctors and other service providers. Moreover, information seeking and giving varied with adoption stages in unexpected ways. In collaboration with Apoyo a Programmas de Población (Advocacy for Population Programs) of Peru, we present a model of how interpersonal communication networks generated by mass media messages vary with stage of behavior change.

Are histamine H1 receptors involved in ischaemia/reperfusion injury in rat heart?

During ischaemia, there was no apparent change in malondialdehyde (MDA) content in rat myocardium. However, reoxygenation resulted in a significant increase in MDA content. The changes evoked by ischaemia and reoxygenation were significantly attenuated by addition of fenistil (histamine H1 receptor antagonist). Enzymatic antioxidant systems were not significantly modified in the different periods of ischaemia and after 30 min of reoxygenation. It is suggested, that maintenance of an adequate endogenous antioxidant reserve during ischaemia may be important in recovery upon reoxygenation.

Street theater as a tool to reduce family planning misinformation.

Mass media campaigns can be effective at communicating health information to a mass audience rather inexpensively. Critics of mass media health campaigns often contend, however, that interpersonal communication is more effective at changing behavior. Conversely, interpersonal communication activities to promote health can be effective at changing behavior, but critics have argued that they have certain limitations such as being expensive and personal (perhaps intrusive), and that they provide nonstandardized information. The present study is an evaluation of a street theater format in Peru that combined the advantages of mass and interpersonal communication to improve family planning knowledge and attitudes. The street theater was effective in decreasing misinformation concerning modern contraceptive methods.

Students absorb it better.

PIP: Despite 15 years of public sector efforts to provide sex education and information to Mexico's youths, information is virtually nonexistent. This fact is most alarming when one considers that those aged 15-19 years comprise almost 1/3 of the population of Mexico. 16.5 years is the average age of 1st sexual intercourse, 1/3 of the youths use contraception during 1st sexual encounter, and 1/6 of sexually active youths use contraceptives. 24% of births in 1989 were to women under age 20. There is great demand among youths and teachers for sex education. 22 animated sex education films which address this demand are described. "The Blue Pigeon" is generally targeted to those aged 11-16. It helps teachers describe the key elements of human sexuality and the physiological changes of puberty and adolescence. Though criticized by parents, health authorities, and a group of teachers and professors, The Blue Pigeon is well-received by students and teachers and educators who use it. The film serves as a useful, easily understood educational support tool. "Music for Two" is targeted to youths over age 15 in urban and suburban areas and may be suitable for young adults and couples. This film discusses factors involved in choosing a mate. It informs while promoting attitudinal change about sexuality and communication within couples. Field experiences with the 2 films are briefly presented.^ieng

It reaches remote areas.

PIP: Guatemala's population was 8.2 million according to a 1986-87 survey estimate with a growth rate of 2.8% in the course of the previous 28 years. The current rate was estimated at 3.2%, gross birth rate was 41/1000, and the mortality rate was 9/1000. 1/3 of the population lives in urban areas, and 40% are indigenous ethnic groups. The Integrated Project (IP) was carried out in Solola state in the southwest, a highly productive region with poor health indicators, and lack of safe drinking water, drainage, latrines, and electricity. IP covered a population of 18,600. The Guatemalan Family Welfare Association (APROFAM) in operation since 1965 executed the IP effort. APROFAM has 18 department clinics, 13 medical centers, and 2050 trained voluntary extension workers in addition to doctors, nurses, and auxiliary personnel. The IP effort on control of intestinal parasites was integrated with family planning (FP), and it was launched in 1989 with the school-age population. An evaluation of methodology during 1992-95 was designed to improve IP and consisted of semistructured interviews and informal talks with directors, mayors, female FP users, beneficiaries of parasite control, and focus groups. A baseline study indicated that parasitism was considered dangerous, as there was close to a 90% rate of infection. In 1989 there were only 38 pill users, 161 condom users, and 15 users of vaginal methods. In 1991 there were 222 pill users, 445 condom users, 65 vaginal method users, and 16 persons were referred for sterilization. In 1988 only 6.1% used modern methods, while the current rate increased to 16.6%. The Catholic Church was opposed to IP, there was only fledgling sex education, and the involvement of women and the community was envisioned.^ieng

Partial section of the corpus callosum: focal signs and their recovery.

A 30-year-old woman underwent surgical partial callosotomy (posterior half) for removal of an arteriovenous malformation. The patient submitted to neuropsychological evaluation before and after surgery for a period of 8 months. There was transient dysfunction attributable to disconnection of parietal, temporal, and occipital connections. Because the symptoms disappeared over time, we conclude that the transcallosal surgical approach can, in the long term, be considered a relatively harmless method.